scholarly journals Association of neighbourhood deprivation with risks of major amputation and death following lower limb revascularisation

2020 ◽  
Vol 306 ◽  
pp. 11-14
Author(s):  
Katriina Heikkilä ◽  
Ian M. Loftus ◽  
Sam Waton ◽  
Amundeep S. Johal ◽  
Jonathan R. Boyle ◽  
...  
Keyword(s):  
Lower Limb ◽  
Major Amputation ◽  
Neighbourhood Deprivation

Safety aspect of intraoperative, local urokinase lysis in patients with acute lower limb ischemia

2021 ◽  
pp. 1-10
Author(s):  
Schierling Wilma ◽  
Bachleitner Kathrin ◽  
Kasprzak Piotr ◽  
Betz Thomas ◽  
Stehr Alexander ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Artery Occlusion ◽  
Outflow Tract ◽  
Intracranial Bleeding ◽  
Minor Bleeding ◽  
Free Survival ◽  
Lower Limb Ischemia

BACKGROUND: Acute lower limb ischemia (ALI) is associated with a high risk of limb loss and death. OBJECTIVE: The present study evaluates the safety of intraoperative, local urokinase lysis in patients with ALI and crural artery occlusion. METHODS: A total of 107 patients (115 legs) were treated surgically for ALI with additional intraoperative urokinase lysis to improve the outflow tract. Minor and major bleeding as well as efficacy of treatment and amputation-free survival were investigated. RESULTS: Complete restoration of at least one run-off vessel was achieved in 64%. Collateralization was improved in 34%. Lysis failed in 2%. Major amputation rate was 27%overall (12%within 30 days) and depended on Rutherford class of ALI (overall/30 day: IIa 11%/6%; IIb 20%/17%; III 37%/15%). Amputation-free survival turned out to be 82%after 30 days, 58%after one, and 41%after five years. Minor bleeding occurred in 21%(24/115) and major bleeding in 3.5%(4/115). One of these patients died of haemorrhage. No patient experienced intracranial bleeding. CONCLUSION: Intraoperative urokinase lysis improves limb perfusion and causes low major and intracranial bleeding. It can be safely applied to patients with severe ischaemia when surgical restoration of the outflow tract fails.

scholarly journals Factors that affect the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population

2021 ◽  
Vol 28 ◽  
pp. 221049172110569
Author(s):  
Pui M Chung ◽  
Bolton KH Chau ◽  
Esther C-S Chow ◽  
Kwok H Lam ◽  
Nang MR Wong
Keyword(s):  
Mortality Rate ◽  
Lower Limb ◽  
Chinese Population ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Hong Kong Chinese ◽  
Limb Amputation ◽  
The Mean ◽  
One Year ◽  
The One

Introduction Lower limb amputation has significant morbidity and mortality. This study reviews the potential factors affecting the one-year mortality rate after lower limb amputation in the Hong Kong Chinese population. Methods Cases with lower limb amputations (toe, ray, below-knee, and above-knee amputations) from a regional hospital from January 2016 to December 2017 were recruited. Amputations due to trauma were excluded. The one-year mortality rate and the potential risk factors (age, sex, length-of-stay, multiple operations, extent of surgery (minor vs. major), medical comorbidities including (1) end-stage renal failure (ESRF), (2) cardiac diseases, (3) ischemic heart disease, (4) peripheral vascular disease and (5) diabetes mellitus) were analyzed by multiple logistic regression using Matlab 2018a. Results A total of 132 patients were recruited (173 operations). The one-year mortality rate was 36.3%. The mean age at death was 72.2 years. The results of the regression analysis showed patients having ESRF (β = 2.195, t 120 = 3.008, p = 0.003) or a major amputation (including above- or below-knee amputation) (β = 1.079, t 120 = 2.120, p = 0.034), had a significantly higher one-year mortality. The remaining factors showed no significant effect. The one-year mortality rate in ESRF patients was 77.8%; while the one-year mortality rate without ESRF was 29.8%. The mean age at death in the ESRF group was 62.9 years; while that without ESRF was 76.1 years. The one-year mortality for patients with major amputation was 45.8% while that for minor amputation was 20.4%. Conclusion ESRF and major amputation are factors that increase the one-year mortality rate after lower limb amputation.

scholarly journals What happens to our amputees? The Darling Downs experience

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902095847
Author(s):  
Varun Vasudeva ◽  
Adam Parr ◽  
Alan Loch ◽  
Chris Wall
Keyword(s):  
Lower Limb ◽  
Treatment Options ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Mortality Data ◽  
Minor Amputation ◽  
Poor Outcomes ◽  
American Society ◽  
End Stage

Background: Major lower limb amputation is occasionally required in the management of end-stage pathology where other treatment options have failed. The primary aim of this study was to determine the 30-day and 1-year mortality rates of patients undergoing nontraumatic major lower limb amputation. Secondary aims were to investigate risk factors for poor outcomes, incidence of previous minor amputation, and the rate of subsequent major amputation. Methods: All nontraumatic, major lower limb amputations performed at Toowoomba Hospital during an 18-year period were retrospectively reviewed. Mortality data were obtained from the Queensland Registry of Births, Deaths and Marriages. Kaplan–Meier analysis was performed to determine survival after amputation. Results: A total of 147 patients were included in the study, with 104 undergoing below knee and 43 undergoing above knee amputations. Ten patients identified as having an Aboriginal and Torres Strait Islander background. For all patients, the 30-day mortality was 4.1% and 1-year mortality was 21.1%. For Indigenous patients, 30-day mortality was 10%. Previous minor amputation had occurred in 40 patients. Twenty-nine patients underwent further minor surgery after their initial major amputation, with thirteen requiring subsequent major amputation. Factors that increased mortality risk were the presence of peripheral vascular disease, an American Society of Anesthesiologists score of four and age greater than 65 years. Conclusion: The morbidity and mortality following major lower limb amputation is significant. The findings of this study highlight the importance of preventative measures to minimize the incidence of lower limb amputations in the future.

scholarly journals Delay Influences Outcome after Lower Limb Major Amputation

2012 ◽  
Vol 44 (5) ◽  
pp. 485-490 ◽  
Author(s):  
P.W. Moxey ◽  
D. Hofman ◽  
R.J. Hinchliffe ◽  
J. Poloniecki ◽  
I.M. Loftus ◽  
...  
Keyword(s):  
Lower Limb ◽  
Major Amputation

scholarly journals 800 The Impact of the COVID-19 Pandemic on The Management of Patients with Vascular Conditions: The Vascular and Endovascular Research Network (VERN) COVID-19 Vascular Service (COVER) Tier 3 Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Birmpili ◽  
Keyword(s):  
Lower Limb ◽  
Healthcare Delivery ◽  
Operative Management ◽  
Major Amputation ◽  
Management Plan ◽  
Aortic Aneurysms ◽  
Research Network ◽  
Treatment Standard ◽  
Suboptimal Care ◽  
The Impact

Abstract Introduction The COVID-19 pandemic has had significant impact on healthcare delivery internationally. The aim of this study was to evaluate the changes in the management of vascular conditions during the COVID-19 pandemic compared to pre-pandemic standards. Method An international multicentre prospective cohort study was conducted over a 4-week period from March 2020. All patients referred to vascular services with acute vascular conditions were eligible to participate. Data on patient demographics, diagnosis and treatment delivered during the pandemic were collected. If there was a deviation from the pre-pandemic management plan, this ‘ideal’ plan was recorded, and the severity of modification scored on a 5-point scale. Results A total of 1801 patients from 52 centres in 19 countries were included in the study, most commonly referred with lower limb conditions (54.4%). Only 2.3% of patients had a confirmed diagnosis of COVID-19. A deviation from the pre-pandemic treatment standard occurred in 35% of unruptured ≥5.5cm diameter abdominal aortic aneurysms, 24.7% of patients with carotid disease, 17% with acute or chronic limb-threatening ischaemia and 12.7% with diabetic foot conditions. Of these modifications, 40.7% were significant, such as endovascular instead of open aneurysm repair or treatment delays, 38.1% major, such as non-operative management of carotid and lower limb disease, and 4.9% life-changing/ending including major amputation or palliation. Conclusions The COVID-19 pandemic has significantly impacted upon the management decisions for vascular conditions, independent of COVID status, with 17% of all-referred patients receiving suboptimal care due to limited resources and difficulty accessing services.

Lower limb amputation following venous cannulation for VA-ECMO: a case report

Perfusion ◽  
2021 ◽  
pp. 026765912110506
Author(s):  
Natasha Habr ◽  
Jamal J Hoballah ◽  
Jamil Borgi ◽  
Caroline Hamadi ◽  
Pierre Sfeir ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Major Amputation ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Venous Cannulation ◽  
Knee Amputation ◽  
Venous Cannula ◽  
Arterial Insufficiency ◽  
Va Ecmo

Lower limb amputation following arterial cannulation for VA-ECMO has been described in the literature. Limb ischemia however following venous cannulation is very rare and not quite understood. We present a case of limb ischemia following venous cannulation. A combination of venous congestion, compartment syndrome and subsequent arterial insufficiency is the proposed pathophysiology. Shock and use of vasopressors are compounding factors. Limb ischemia can be transient and reversible if diagnosed immediately and treated by early removal of the cannula. Our patient was unstable and ECMO dependent, and removal of the cannula was not an option. This resulted in limb loss and eventual above knee amputation. Use of the smallest appropriate venous cannula and early fasciotomy, in addition to hemodynamic optimization are measures that could help in preventing major amputation.

scholarly journals Treatment of critical lower limb ischemia using a hybrid technique

2014 ◽  
Vol 13 (3) ◽  
pp. 257-261
Author(s):  
Ricardo Wagner da Costa Moreira ◽  
Pedro Victor Alcântara da Costa ◽  
David Domingos Rosado Carrilho
Keyword(s):  
Effective Treatment ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Treatment Method ◽  
Major Amputation ◽  
Aortic Aneurysms ◽  
Hybrid Technique ◽  
Endovascular Techniques ◽  
Critical Ischemia ◽  
Lower Limb Ischemia

Critical ischemia of a lower limb is a condition that threatens its viability and must be treated promptly to avoid major amputation. Revascularization is the most effective treatment method and is performed using surgical or endovascular techniques. For patients with thoracoabdominal aortic aneurysms, combining these two approaches into a "hybrid technique" makes it possible to treat patients who could not be adequately treated by either technique in isolation. We report on a case of lower limb critical ischemia treated using a combination of surgery and endovascular techniques, in an application of the hybrid technique in a different arterial bed.

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